We reviewed 458 patients who visited St Marianna University Hospital with the chief complaint of pigmented freckles. They consisted of 410 women and 48 men. The respective mean age at the first visit was 47.4 +/– 13.9 years for the females and 44.5 +/– 22.1 for the males. They consisted of solar lentigo (senile pigmented freckle), melasma, acquired symmetrical dermal melanocytosis, nevus of Ota and so on. Solar lentigo on the face was found in 229 women and 26 men, and that on the extremities was detected in one man and 88 women. There was a significant difference between male and female as shown by the 2×2 chi squire test. Our data showed a great difference between the male and female patients. Both men and women complained about the lesions and required therapy. However, according to Ueno’s study, solar lentigo occurs equally in both genders. We examined 100 patients with ASDM. Clinical, histological and etiological aspects of the disease were described.
To determine and investigate the cutaneous side-effects, we clinically examined in forty-two non-small-cell lung cancer patients treated with Gefitinib (Iressa®), a selective epidermal growth factor receptor tyrosine kinase inhibitor. Twenty-five patients (59.5%) had cutaneous reactions. Frequent adverse events were dry skin (38%), acneiform follicular eruption (33%), seborreheic dermatitis (16.7%), finger scale and fissure (16.7%). In addition, paronychia were found. Dry skin and asteatotic eczema were improved with corticosteroid and moisturizer, acneiform follicular eruption was treated with ibuprofen piconole cream, seborrheic dermatitis was treated with Ketoconazol and corticosteroid cream. Most eruptions were mild (grade 1/2) and improved with those treatments, but 2 patients stopped the medication of Gefinitib because of skin eruptions. The frequency of death between cutaneous reactions group and no eruptions group had no differences.
Pustulosis palmaris et plantaris (PPP) is a disease characterized by the development of aseptic pustula in the palms and/or planta. PPP is an infection with a tonsillar focus, and therefore, tonsillectomy has been performed in patients with intractable PPP. We evaluated the clinical effect of tonsillectomy in patients with PPP (tonsillectomy group: 23 patients, control group : 57 patients). Patients were followed for 1.5 years or longer, and skin lesions were evaluated based on 5-grade scales. Comparison of tonsillectomy and other treatment methods revealed that skin lesions improved in 14 of 23 patients in the tonsillectomy group, but improved in only 10 of 57 patients in the control group. The difference between the two groups was statistically significant (p<0.01). Furthermore, skin lesions were ameliorated in 6 of 8 patients after tonsillectomy who did not show improvement following removal of dental materials due to a positive metal patch test. This effect is more apparent when evaluated over the period from onset of PPP to tonsillectomy (p<0.1). We sent a questionnaire to 23 patients in the tonsillectomy group to examine the side effect of tonsillectomy, and 15 patients replied. 11 patients (73.3%) complied of throat pain and 3 patients (20.0%) complained of temporary aggravation of skin lesions. No patients complained about cost. We conclude that tonsillectomy may be an effective and reliable method for treating PPP.
To evaluate the effect of a short term cyclophosphamide (CYC) pulse regimen on interstitial pneumonia (IP) in patients with systemic sclerosis (SSc), 7 Japanese patients with SSc (all diffuse cutaneous SSc) were administrated to this study. Those were based on the findings of an abnormal bronchoalveolar lavage (BAL) cell analysis, or recent deterioration in serological markers, such as SP-D and KL-6. All patients received intravenously CYC (15 mg/kg) monthly for 6 months and oral prednisone (10–40 mg daily). The treatment was effective in five of seven patients. Serological markers for interstitial pneumonia decreased following the treatment in these patients. Furthermore, the values for pulmonary function test were unchanged or improved (～10% increase). In addition, interstitial lung shadow detected by computed tomography was slightly improved. However, two of seven patients showed no effect of CYC. Serological markers for interstitial pneumonia were deteriorated during CYC treatment. Then, those patients resistant to CYC were treated with cyclosporine, which was effective for interstitial pneumonia. No side effect was experienced during the CYC treatment; no patients discontinued the therapy. These results suggest that CYC pulse therapy with prednisone may be useful to stabilize or improve interstitial lung disease in SSc patients.
This is a case of immediate-type hypersensitivity, which is induced from dentin resin monomer. The patient was a 44-years-old housewife without allergic constitution. In a little while after the dentin treatment, she complained of redness and itching on whole body. The initial attack occurred immediately after the 9th dentinal treatment. The symptom disappeared for efficacious Intravenous medication of steroid without removal of the composite resin. Her general condition was not critical for whole time, as neither difficulty of breathing nor hypotension was seen except dermal symptom. A prick test was performed to elucidate the cause for the allergy .The result was that the antigens were 4-acryloxyethyltrimellitic acid (4-AET) and 4-acryloxyethyltrimellitic anhydride (4-AETA) certainly, because of the severe wheals with spreading reactions at pricked points on these, diluted 10% in methanol. 4-AET and 4-AETA are ethyl-methacrylate monomers. They are utilized on the adhesion of the seal materials (resin, metal and ceramics) to the dentin due to polymerization by visible light. It was inferred that the sensitization to 4-AET, 4-AETA was exhibited for a few seconds, to be polymerized resin from monomer, and the antigenicity disappeared at the moment of the completion of polymerization. Through the dentin canal of caries, the antigens invaded to the circulating system of dental pulp. Therefore her oral cavity had no exanthema and she was not attacked with severe anaphylaxis shock.
The effects of cyclosporine, an immunosuppresant, were studied in five Japanese patients suffering from mucocutaneous type pemphigus vulgaris (PV-MC). All patients have proceeded to medium-to-high doses of oral prednisolone (PSL) (40–60 mg/day), but still remained inadequently controllable and had persisted oral and/or cutaneous manifestations or lesions frequently relapsed. Their clinicopathological features were assessed after oral administration of cyclosporine (CYA) (4–4.8 mg/kg/day) in combination with on-going steroid therapy. Most patients (4/5, 80%) made an impression of achieving to reduce daily dosages of PSL compairing before and after treatment. Particularly in patients with relapsed disease (2/2, 100%) the clinical activity dramatically decreased within 19 days of the combined therapy. Furthermore as assessed by ELISA specific for desmogleins 1 and 3, the serum antibody titers in all five subjects became low within 12–57 days (mean±SD, 34.6±18.0 days) after CYA administration, and subsequently negative (3/5, 60%). No obvious side effects were noted during the combination therapy. The CYA combination therapy may thus be one of the treatment options in pemphigus patients who are unresponsive to standard steroid monotherapy.